剖宫产瘢痕妊娠的诊断及治疗

目的 探讨剖宫产术后子宫切口瘢痕妊娠(caeflarean scar pregnancy,CSP)的早期诊断及治疗方法.方法 通过病案系统,对我院2004年1月～2010年12月收治的34例CSP的临床资料进行回顾性分析,年龄(31.7±4.4)岁.28例有无痛性不规则阴道出血,7例人工流产失败,7例药物流产失败.34...

Diagnosis and Treatment of Caesarean Scar Pregnancy

Objective To explore the early diagnosis and treatment of caesarean scar pregnancy（CSP）.Methods We analyzed retrospectively 34 cases of CSP,who were treated in our hospital from January 2004 to December 2010.The average age of the patients was（31.7±4.4） years.Among them,28 patients demonstrated painless vaginal bleeding,7 patients failed in artifical abortion,and 7 failed in medicinal abortion.All the cases were confirmed by vaginal or abdominal color Doppler.Their serum level of human chorionic gonadotropin increased to 33.3-143 705.5 mIU/ml with a median of 19 461.9 mIU/ml.Uterine artery embolization curettage,hysteroscopy combined with laparoscopic surgery,conservative treatment with methotrexate injection,or cervical hysterectomy were performed accordingly.Results All the patients were cured without deaths.Curettage was successfully carried out after uterine artery embolization in 15 cases with an intraoperative blood loss of 5-20 ml（median 10 ml）,and a hospital stay for 3-11 days（median,8 days）.Hysteroscopy combined with laparoscopic surgery were completed in 6 cases with an intraoperative blood loss of 30-600 ml（median 65 ml）,and a hospital stay of 8-20 days（median 9 days）.Cervical injection of methotrexate was performed on 11 cases,5 of them were successfully cured with a hospital stay for 10 to 72 days（median 37 days）;the other 6 patients were converted to curettage under the guidance by hysteroscopy or ultrasonography,during which 5-400 ml blood was lost,the postoperative hospital stay was 36 days（14-72 days）.Hemorrhagic shock occurred in 2 cases during emergency hysterectomy,no complications after that.Conclusions Vaginal or abdominal color Doppler is an effective method for early diagnosis of CSP.We shall follow the principle of minimal invasion,thorough treatment and quick recovery,to select individualized treatment.